Department of Research & Design, Jacaranda Health, Nairobi, Kenya.
Independent Researcher, Nairobi, Kenya.
PLoS One. 2020 Sep 30;15(9):e0239213. doi: 10.1371/journal.pone.0239213. eCollection 2020.
It is estimated that one third of maternal deaths in Kenya in 2014 could have been prevented by more timely care-seeking. Mobile health interventions are increasingly being recognized as tools for the delivery of health education and promotion. Many maternal deaths occur in the first few weeks after delivery and mothers who are given adequate care in the postpartum period have better health outcomes. Kiambu County, Kenya has a high level of literacy and phone ownership amongst mothers delivering in public hospitals and was chosen as a site for a postpartum short message service intervention.
Women were recruited after delivery and randomized to receive a package of mobile messages or standard of care only. Messages covered danger signs, general postpartum topics, and family planning. Endline phone surveys were conducted at 8 weeks postpartum to assess knowledge, care seeking behavior and family planning uptake. Analysis was conducted using Stata and is presented in odds ratios.
Women who received the danger sign messages were 1.6 times more likely to be able to list at least 1 danger sign and 3.51 times more likely to seek treatment if they experienced postpartum danger signs. There was no significant difference in routine postpartum care seeking or care seeking behaviors concerning newborns. Women who received family planning messages were 1.85 times more likely to uptake family planning services compared to controls and 2.1 times more likely to choose a long-acting method.
Simple, low-cost mobile interventions can support women in the early postpartum period when the information is targeted to particular points in the postpartum continuum. Additional research is needed to understand the interplay between healthcare providers and mobile health interventions. Health policy makers should consider direct mobile interventions for women as an option for supporting positive maternal health outcomes in certain populations.
据估计，2014 年肯尼亚有三分之一的孕产妇死亡本可以通过更及时的寻求医疗服务来预防。移动医疗干预措施正日益被视为提供健康教育和促进的工具。许多孕产妇死亡发生在分娩后的头几周，在产后期间得到充分照顾的母亲会有更好的健康结果。肯尼亚基安布县的产妇在公立医院分娩时，文化程度和手机拥有率都很高，因此选择该县作为产后短信息服务干预的试点。
在分娩后招募妇女，并随机分配接受移动信息包或仅接受标准护理。信息涵盖危险信号、一般产后主题和计划生育。在产后 8 周进行终点电话调查，以评估知识、寻求医疗服务行为和计划生育的采用情况。使用 Stata 进行分析，并以优势比呈现。
收到危险信号信息的妇女能够至少列出 1 个危险信号的可能性是对照组的 1.6 倍，如果出现产后危险信号，寻求治疗的可能性是对照组的 3.51 倍。在常规产后寻求医疗服务或新生儿护理行为方面，没有显著差异。收到计划生育信息的妇女采用计划生育服务的可能性是对照组的 1.85 倍，选择长效方法的可能性是对照组的 2.1 倍。
简单、低成本的移动干预措施可以在产后早期为妇女提供支持，此时信息针对产后连续体的特定点。需要进一步研究以了解医疗保健提供者和移动医疗干预措施之间的相互作用。卫生政策制定者应考虑将直接的移动干预措施作为支持特定人群中积极产妇健康结果的选择。
